The impact of OI on jaw function and oral health-related ... › docs › seehearsmile ›...
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The impact of OI on jaw function and oral health-related quality of life Head of center Hans Gjørup consultant orthodontist, DDS, PhD Center for Oral Health in Rare Diseases Dept. of Maxillofacial Surgery, Aarhus University Hospital, Denmark
Transcript of The impact of OI on jaw function and oral health-related ... › docs › seehearsmile ›...
TheimpactofOIonjawfunctionandoralhealth-relatedqualityoflife
HeadofcenterHansGjørupconsultantorthodontist,DDS,PhD
CenterforOralHealthinRareDiseasesDept.ofMaxillofacialSurgery,AarhusUniversityHospital,Denmark
CenterforOralHealthinRareDiseasesCollaborationbetween
Dept.ofMaxillofacialSurgery,AarhusUniversityHospitalDepartmentofDentistryandOralHealth,AarhusUniversity
Centralization of specialized oral health care service for people with rare inherited diseases
DentalsymptomsinadultswithOI
• Dentinogenesisimperfecta(DI)– Discolorationofteeth– Pulpalobliteration– Deviationsindentalmorphology
• DIin25%ofpatientswithOI– Type3-4: 94%withDI– Type1: 2%withDI
• Enamelandcrownfractures
• Thuesenetal2018
CraniofacialmorphologyandocclusioninpatientswithOI
• Relativemandibularprognatismandmandibularoverjet– Stenviketal1985– WaltimoSirenetal2005
• MostseverecraniofacialabnormalitiesinOItype3and4
• NearnormaljawmorphologyinOItype1– Jensen&Lund1997
• Mandibularoverjet&posteriorcrosbiteprevalentiOItype3and4– Bendixenetal.2018
Nessecitiesfortheabilitytochew,eat,speak,andsmile:Structuresoftheorofacialcomplex
Jaw&teeth
TandlægeforeningenDK ThiemeAtlasofAnatomy
MusclesTMjoint&discus
ThepresenceofdentalabnormalitieslikeDIandskeletalabnormalitieslikeOI,
aswellasthepresenceofmalocclusionmighthaveimpacton
jawfunctionandoralhealth-relatedqualityoflife
Badjawfunction=TemporomandibulardisorderTMD
• TMDareaheterogeneousgroupofpathologiesaffectingthetemporomandibularjoint(TMJ),thejawmuscles,orboth.
• McNeillC.Managementoftemporomandibulardisorders:conceptsandcontroversies.JProsthetDent1997;77:510-22.
• Theyarecharacterizedbyaclassicallydescribedtriadofclinicalsigns:– muscleand/orTMJpain;– TMJsounds;– andrestriction,deviation,ordeflectionofthemouthopeningpath
• LaskinDM.Etiologyofthepain-dysfunctionsyndrome.JAmDentAssoc1969;79:147-53.
Aimsofstudyonjawfunction
• toassesstheoccurrenceoftemporomandibulardisorders(TMD)– inadultswithosteogenesisimperfectaand
• tocomparetheoccurrenceofTMD– accordingtoseverityofOI
• ResearchDiagnosticCriteriaforassessentoftemporomandibulardisordersRDC/TMD
– DworkinSF,LerescheL.Researchdiagnosticcriteriafortemporomandibulardisorders:review,criteria,examinationsandspecifications,critique.JCraniomandibDisordFacialOralPain1992;6:301-55
ThiemeAtlasofAnatomy
Studypopulation:75adultswithgeneticallyverifiedOI
OImild(type1) Females MalesNumbers 31 25Age(yr)mean 49(14.5) 49(17.4)Age(yr)range 23-72 22-80
OIsevere(type3/4) Females MalesNumbers 9 10Age(yr)mean 49(12.3) 44(10.3)Age(yr)range 37-72 28-63
Diagnosesonmyofacialpainin56withOII–19withOIIII/IV–100general–100TMD
ThiemeAtlasofAnatomy
5 1 1045
51 18 9055
0%
20%
40%
60%
80%
100%
OII OIIII/IV
General TMD
RDC/TMDI-myofacialpain
Myofacialpain(1) Nopain
ns
ChronicPainGrade(CPG0-4)in56withOII-19withOIIII/IV
• CPG0:noTMDpaininthepriorsixmonths
• CPG1:lowdisabilityandlowpainintensity
• CPG2:lowdisabilityandhighpainintensity
• CPG3:highdisabilityandmoderatelylimiting
• CPG4:highdisabilityandseverelylimiting
210
1
4418
0%
20%
40%
60%
80%
100%
OII OIIII/IV
ChronicPainGrade
CPGII CPGI CPG0
ns
ConclusionsonOIandjawfunctionBendixenetal2018
• IrrespectiveofOIseverity,veryfewpatientshadTMDdiagnosesonmyofacialpain,discdisplacement,orjointdisorder
• ThebodilypaincomplaintsfrequentlyoccurringinOIwasnotreflectedintheorofacialarea
Nessecitiesfortheabilitytochew,eat,speak,andsmile:Structuresoftheorofacialcomplex
Jaw&teeth
TandlægeforeningenDK ThiemeAtlasofAnatomy
MusclesTMjoint&disc
ThepresenceofdentalabnormalitieslikeDIandskeletalabnormalitieslikeOI,
aswellasthepresenceofmalocclusionmighthaveimpacton
jawfunctionandoralhealth-relatedqualityoflife
Aimofstudyonoralhealth-relatedqualityoflifeinpatientswithrareskeletaldisorders
• Toassesstheimpactuponoralhealth-relatedqualityoflifeintworarediseases,characterizedbythepresenceofbothskeletalanddentalsymptoms(XLHandOI)
• Tocomparetheimpactonoralhealthrelatedqualityoflifeaccordingtothedisease,XLHorOI
Twocross-sectionalstudiesonandOIrespectiveXLHinDenmark
X-linkedHypophosphatemia• PHEXmutation,X-linked• Renaldepletionofphosphateand
hypophosphatemia• Hypomineralizationandsofteningof
bones
• Shortstatureandbowedlegs• Enlargementofgrowthplates• Costachondralthickening
– “rachiticrosary”
• Pulpitisandpulpnecrosis– inteethwithoutdecay
• Dentalabscesses
• RecruitmentbyMDPhDSigneSBeck-Nielsen
OsteogenesisImperfecta• Interdiciplinaryassessment
– Clinical,radiological,histological,genetical,QoL,dexa,otomicroscopical,dentaletc
RecruitmentbyMDPhDJannieDHald
StudypopulationsXLHandOI
XLH Females MalesNumbers 24 11Age(yr)mean(SD) 41(14.6) 42.5(19.6)Age(yr)range 21-75 19-73
OI Females MalesNumbers 40 35Age(yr)mean(SD) 49(13.9) 48(15.7)Age(yr)range 23-73 22-80
Method:quantifyingtheimpactoforalhealthonqualityoflife
Tool:OralHealthImpactProfileOHIP-DSladeandSpencer1994.DevelopmentandevaluationoftheOralHealthImpact
Profile.CommunityDentHealth11:3-11
Standardizedquestionnaire• 49questions• Frequencyofsymptomsorexperiences
• Score0–40=never4=daily/always
7domaines
• Functionallimitations• Physicalpain• Psychologicaldiscomfort• Physicaldisability• Psychologicaldisability• Socialdisability• Handicap
OHIPprofilesbymeans(t-test)inOIsevere,OImild,XLHandReference
P<0.05
Comparison(Wilcoxonrank-sumtest)OIpatients(N=75)andXLHpatients(N=35)
Comparison(Wilcoxonrank-sumtest)MildOI(N=56)andsevereOI(N=19)
Conclusionsonoralhealthrelatedqualityoflife• InbothXLHandOIgroups,thedomainescoresinalldomaines-exceptone(socialdisability)-deviatefromreferencegroup
• TheimpactofXLHexceedstheimpactofOIinnearlyalldomaines– Functionallimitations– Pain– Psychologicaldiscomfort– Psychologicaldisability– Handicap
• AccordingtoOHIP,theimpactofsevereOIhardlyexceedstheimpactofmildOI
ThankyouforyourattentionThankyouforsupportfrom
• participatingpatients• TheDanishSocietyforOsteogenesis
imperfecta• CareforBrittleBones(C4BB)
Thankyouforcollaborationwith• coworkersat
– OdenseUniversityHospital– AarhusUniversityHospital
• Deptofmedicinandendocrinology• CenterforRareDiseases
– DepartmentofDentistryandOralHealth,AarhusUniversity
• thestaffat– Dept.MaxillofacialSurgery,Aarhus
UniversityHospital– DepartmentofDentistryandOralHealth,
AarhusUniversity
HansGjørup:[email protected]
